The below article about about the EJE's Guidance issued in March 2020. This guidance has since been superceded by other materials from other organisations including the Society for Endocrinology.

The EJE articles contents has featured in many online forums and social media posts in a way that misrepresents the intentions of the authors.

We would advise that all people with adrenal insufficiency read and apply the latest ADSHG guidance.

In response to the unprecedented COVID-19 pandemic, the European Journal of Endocrinology (EJE) editoral board commissioned a new guidance series for the management of endocrine conditions during COVID-19 back in March 2020. Included within this was clinical guidance that represented the thinking on management of Addison's disease and adrenal insufficiency at the time.

The guidance is an Open Access publication and can be read by clicking here - "Endocrinology in the time of COVID-19: Management of adrenal insufficiency".

Our huge thanks to authors: Professor Wiebke Arlt, Professor Stephanie Baldeweg, Dr Helen Simpson & ADSHG Trustee Medic Professor Simon Pearce, and all those involved.

Professor Simon Pearce tells us:

"During the pandemic, a lot of medical staff are working in a role outside their usual area of expertise. We were keen to provide simple principles that could be followed by any healthcare worker, not necessarily one experienced in endocrinology, to allow steroid-dependent patients to be managed safely through the COVID19 illness.

 We hope that the key messages will come across:

• People with steroid-dependency need to be prepared, with an adequate supply of hydrocortisone tablets (at least one month extra) and 2 or 3 injections.
• Many people will be able to self-manage their COVID19 illness at home, with an increased dose of hydrocortisone and regular fluid intake and paracetamol.
• However, people should not hesitate to contact medical services or seek hospital admission if the situation deteriorate and they feel increasingly unwell despite these measures."

What does the research paper show?

The guidance details the principals for healthcare workers and indivduals with Addison's or adrenal insufficiency to follow, to safely manage steroid-dependency through the COVID-19 illness and to help prevent adrenal crisis triggered by the COVID-19 infection. The guidance also details the increased medication dosing requirements recommended at this time, should a person with Addison's become unwell with COVID-19.

This provides those of us living with Addison's the appropriate self management support, to manage our condition adequately and safely, at a time when there are capacity issues in the healthcare system.

What does this mean for people with Addison's Disease or Adrenal Insufficiency? 

The guidance reiterates the importance of being prepared with sufficient extra medication and an emergency kit, so you are able to follow the COVID-19 guidance should you become unwell. Here we summarise the further important points from the guidance.

Education 

• Sick Day Rules - make sure you, those you live with and your loved ones, are familiar with the Sick Day Rules. Increased hydrocortisone stress dose cover is required for those with COVID-19, watch our video for futher explanation.
• Follow stringent social distancing rules.
• As recommended for all affected by COVID-19, rest, take regular paracetamol and keep well hydrated, drinking water reguarly even through the night.

Equipment

• Have your own steroid emergency self-injection kit - read here for more information on preparing your injection kit.
• Sufficient steroid supplies - make sure you have got enough hydrocortisone in the house to take into account the need to increase your replacement dose in response to the COVID-19 infection. If not, contact your GP or endocrinologist immediately and get those extra tablets available. 

Empowerment 

• Ensure you have printed copies and are familiar with the NHS Steroid Card and COVID-19 Guidelines. 

All these can help prevent an adrenal crisis!

Thank you EJE for carrying out this urgent work to learn more about how the specific ways the virus affects people living with Addison's. Our hope is that the distribution of this new guidance help improves the advice and understanding of how to manage COVID-19 should someone with Addison's or adrenal insufficiency become unwell during this uncertain time.

The guidance is an Open Access publication and can be read by clicking here - "Endocrinology in the time of COVID-19: Management of adrenal insufficiency".